As COVID-19 continues to strain our public health and healthcare systems, leaders are already grappling with another question: How will these systems need to adapt to a post-COVID-19 world?

During a recent* interview on the podcast “The New Normal: Conversations About the Future of Healthcare,” with host Chris Boyer, de Beaumont Foundation President and CEO Brian C. Castrucci explained how the social determinants of health have been underscored throughout the COVID-19 pandemic, with imbalances in health equity more pronounced than ever.

Castrucci shared the following points over the course of the wide-ranging discussion on public health, healthcare, and the impact of COVID-19 on society:

We Need to Recognize That Health is More Than Healthcare.

“Public health and health care are part of the same stream. We’re just at different parts. Ultimately, if public health is working, then there should be less of a burden on healthcare. You go to get healthcare when you’re sick. And public health is working at a community level to ensure that everyone has their optimal chance at living their best life. When you pair good policy and strong community health with the exceptional healthcare that we have in this country, that’s the path to excellent health…

Health is the foundation for everything that we do. But we’ve chronically underfunded half of that equation. Public health gets very little funding when you compare it to healthcare, when you compare it to defense. We need to prioritize health, not just healthcare, if we want to actually meet the expectations that we have for our country.”

The Goal is Health Equity, Not Equality.

“When you think about health, we make a lot of our individual choices, but those choices are shaped by our environment. When you’re meeting with your doctor, and he or she says you should exercise more, that’s a good suggestion. But do I even have a place to exercise? Can I walk safely at night? Eat healthier? Where do I eat healthier? Do I have access to fresh fruits and vegetables? Can I afford to buy fresh fruits and vegetables?…

You don’t really think about the foundation of your house until something goes drastically wrong. Public health is that foundation, and right now, we’re seeing all of the cracks in our foundation. And we need to invest in those cracks. Because what you see right now is that when that foundation fails, everything else can come to a halt.”

Coronavirus Testing Must Be Scaled Up. Now.

“Many countries are far ahead of the U.S. right now. Typically, the U.S. is a leader. In this case, we need to look at what other countries have done, and it really comes down to testing. Contact tracing requires someone to be an index case. So either I need to be sick and get tested and I’m positive, or I have population-level testing until I come up as positive. And even though I’m not sick, I can still trace my contacts. That’s a huge challenge. And it’s one that we need every bit of American ingenuity, technology, innovation, entrepreneurialism, to come together and try to solve.”

Health Is Never an Individual Story.

“We’ve hit a point in our culture where we think we only have to clean half the fish tank and somehow all the fish will live. Well, if you clean half the fish tank, eventually all the fish die. We live collectively. There’s no way around that. But it’s something we have conveniently forgotten. …Health is becoming a luxury item. And that’s scary.”

Structural Change Is More Important Than Charity.

“I don’t think we need charity, I think we need change. There was tons of money that went in after Katrina and after other natural disasters. …It’s our natural response. And there are going to be, and there already have been, COVID-19 fundraisers and concerts and telethons and all these things. We are an extraordinarily generous country when it comes to charitable giving, but then we don’t want to make the change. We need policies to change the rules.”

*This interview was recorded before the recent Black Lives Matter protests, a critical issue in our ongoing discussions of health equity and racism. Read the de Beaumont Foundation’s full statement here.

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